Organization
NORTHWESTERN ORAL & MAXILLOFACIAL SURGEONS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXIS B OLSSON DDS (PRESIDENT)
(312) 926-6333
Entity
Organization
Contact information
Practice address
201 E HURON ST, SUITE 12-100, CHICAGO, IL 60611-3197
(312) 926-6333
(312) 926-3444
Mailing address
201 E HURON ST, SUITE 12-100, CHICAGO, IL 60611-3197
(312) 926-6333
(312) 926-3444
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
021.001615
IL
Other
Enumeration date
09/14/2011
Last updated
09/14/2011
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